Mamoplastia de reducción y medialización del complejo areola-pezón en paciente acondroplásica con gigantomastia. Caso clínico / Reduction mammoplasty and nipple medialization in achondroplasic patient with gigantomastia. Case report

La acondroplasia es una enfermedad genética rara que representa la forma más común de enanismo de extremidades cortas. Existen pocos casos reportados de gigantomastia y subsecuente cirugía mamaria en esta población. Presentamos el caso de una paciente con acondroplasia, gigantomastia y medialización de pezón que requirió mamoplastia reductora y reposición de complejo areola pezón (CAP). Se utilizó la técnica de T invertida con pedículo inferior. La planeación quirúrgica y el correcto marcaje en pacientes acondroplásicos son pasos importantes para una cirugía exitosa teniendo en cuenta que las referencias anatómicas habituales no son guías confiables para un posicionamiento ideal de la mama en el tórax o del CAP en la mama. (AU)

Achondroplasia is a rare genetic disease representing the most common form of short-limb dwarfism, and there are a few case reports of gigantomastia and subsequent breast surgery in this patient population. We present the case of a patient with achondroplasia, gigantomastia and nipple medialization who required a reduction mammaplasty and reposition of the nipple areola complex (NAC). An inverted T technique with an inferior pedicle was used. Surgical planning and correct marking in achondroplasic patients are important steps for a successful surgery considering that common anatomical landmarks are not a reliable guide for ideally positioning the breast on the thoracic wall or the NAC on the breast. (AU)

Quiste epidérmico de dimensiones excepcionales en región lumbosacra: caso clínico / Exceptional dimensions epidermal cyst in the lumbosacral region: case report

Presentamos el caso clínico de un paciente de 57 años con tumoración de tejidos blandos a nivel lumbosacro de 30 años de evolución, de 17 x 13 x 9 cm en sus diámetros máximos. Incluimos en detalle el procedimiento diagnóstico y terapéutico seguido así como el reporte histopatológico, consistente en un quiste epidérmico de inclusión.Presentamos este caso por las excepcionales dimensiones de la tumoración y llevamos a cabo una revisión de la literatura al respecto con el fin de actualizar la información sobre esta patología. (AU)

We present the clinical case of a 57-year-old patient with a lumbosacral soft tissue tumor of 30 years of evolution, measuring 17 x 13 x 9 cm in its maximum diame- ters. We include in detail the diagnostic and therapeutic procedures followed, as well as the histopathological report, consisting of an epidermal inclusion cyst.The main interest of this case is the exceptional dimension of the cyst, and by the way, we carried out a literature review in this regard in order to update the information on this pathology. (AU)

Solitary infantile gastrointestinal myofibroma: case report.

We report a case of a 7-year-old child who required emergency surgery for acute abdomen and suspected acute appendicitis. During surgery a tumor located in the small bowel that caused intestinal occlusion was found. Histopathologic analysis showed a solitary gastrointestinal myofibroma. This is a very rare tumor, especially as a single lesion, because in world literature, there are less than 10 cases reported.

[Acute intestinal ischemia serum markers for the diagnosis of acute appendicitis]. / Marcadores séricos de isquemia intestinal aguda para el diagnóstico de apendicitis aguda.

INTRODUCTION: Acute appendicitis is the most common surgical emergency of the abdomen, but is still misdiagnosed in a large number of cases because of the the poor accuracy of the different radiologic and laboratory exams. Like in intestinal ischemia, an ischemic factor causes necrosis of the appendiceal wall and this favors the release of particular biochemical serum markers. OBJECTIVE: To evaluate the efficacy of intestinal ischemia serum markers as a diagnostic test for acute appendicitis. MATERIAL AND METHODS: Two hundred patients were studied prospectively. Depending on results of the examination by a surgeon, patients underwent surgery for acute appendicitis. Serum levels of amylase, lactic dehydrogenase, alkaline phosphatase, alanine transaminase, aspartate transaminase and leucocyte count were taken preoperatively. We then compared the results with histopathologic findings. RESULTS: Appendicitis was confirmed in 176 patients. Leukocytes had the highest sensitivity but very low specificity. Amylase and DHL were very specific but their sensitivity was poor. Differential leukocyte count had the highest positive predictive value. CONCLUSIONS: Serum enzymes of intestinal ischemia are not useful markers for the diagnosis of acute appendicitis. Leukocyte count is still the most useful serum marker of appendicitis.

[Splenic hydatid cyst. Case report of a pregnant woman]. / Quiste hidatídico esplénico. Reporte de un caso en una mujer embarazada.

Hydatid disease is caused by larvae of the platyhelminth parasite called Echinococcus; it generally lodges in liver and lung, and less commonly in spleen. In Mexico, hydatid disease has a very low frequency; only few cases of lung disease have been reported. In this paper, case of a 7 weeks pregnant female patient with a simple cyst in spleen identified by ultrasound and tomography is reported. The patient underwent splenectomy. Diagnosis of hydatid cyst was confirmed by histopathology. This case suggests that hydatid disease should be considered as differential diagnosis in every patient with a cystic mass of the spleen.